Laboratory testing is limited in discriminating among these three clinical situations.
| . | Case A . | Case B . | Case C . | |||
|---|---|---|---|---|---|---|
| . | Chronic, stable, severe hepatic insufficiency . | Dilutional coagulopathy . | Disseminated intravascular coagulation . | |||
| . | Level . | Score . | Level . | Score . | Level . | Score . |
| These levels represent ranges typically encountered within such patient scenarios. | ||||||
| *ISTH Scoring algorithm: platelet count (> 100,000 = 0; < 100,000 = 1; < 50,000 = 2); elevated fibrin-related marker (no increase = 0; moderate increase = 2; strong increase = 3); prolonged prothrombin time (< 3 sec = 0; > 3 but < 6 sec = 1; > 6 sec = 2); fibrinogen level (>1.0 g/L = 0; <1.0 g/L = 1). Maximal score, 8; if score ≥ 5, compatible with DIC; if score <5, not affirmative for DIC. | ||||||
| ISTH indicates International Society of Thrombosis and Haemostasis; DIC, disseminated intravascular coagulation; PT, prothrombin time, ATIII, antithrombin III; PTT, partial thromboplastin time. | ||||||
| ISTH DIC TESTS* | ||||||
| Platelet count/μL | 80,000 | 1 | 70,000 | 1 | 60,000 | 1 |
| D-dimer, μg/mL | 2 | 2 | 2 | 2 | 3 | 2 |
| PT, seconds prolonged | 6 | 2 | 7 | 2 | 6 | 2 |
| Fibrinogen, mg/dL | 85 | 1 | 70 | 1 | 90 | 1 |
| Total ISH score | 6 | 6 | 6 | |||
| Other Coagulation Tests | ||||||
| ATIII level, % normal (nL) | 30–50 | 30–50 | 30–50 | |||
| Plasminogen level, % nL | 30–50 | 30–50 | 30–50 | |||
| Most coagulation factors, % nL | 30–50 | 30–50 | 30–50 | |||
| Factor VIII activity, % nL | 80–200 | 30–50 | 50–80 | |||
| PTT 1:1 mix with plasma | Usually corrects | Always corrects | Rarely corrects | |||
| Other Features | ||||||
| Pathophysiology | Decreased protein synthesis | Effects of dilution | Increased consumption | |||
| Thrombin generation | Intact but sluggish | Maintained | Excessive | |||
| Systemic hemorrhage | Uncommon | None | Characteristic | |||
| Systemic thrombosis | Rare | None | Characteristic | |||
| Hematologic treatment | Nonspecific | Platelets, fresh frozen plasma, cryoprecipitate | Aimed at any instigating circumstance | |||
| . | Case A . | Case B . | Case C . | |||
|---|---|---|---|---|---|---|
| . | Chronic, stable, severe hepatic insufficiency . | Dilutional coagulopathy . | Disseminated intravascular coagulation . | |||
| . | Level . | Score . | Level . | Score . | Level . | Score . |
| These levels represent ranges typically encountered within such patient scenarios. | ||||||
| *ISTH Scoring algorithm: platelet count (> 100,000 = 0; < 100,000 = 1; < 50,000 = 2); elevated fibrin-related marker (no increase = 0; moderate increase = 2; strong increase = 3); prolonged prothrombin time (< 3 sec = 0; > 3 but < 6 sec = 1; > 6 sec = 2); fibrinogen level (>1.0 g/L = 0; <1.0 g/L = 1). Maximal score, 8; if score ≥ 5, compatible with DIC; if score <5, not affirmative for DIC. | ||||||
| ISTH indicates International Society of Thrombosis and Haemostasis; DIC, disseminated intravascular coagulation; PT, prothrombin time, ATIII, antithrombin III; PTT, partial thromboplastin time. | ||||||
| ISTH DIC TESTS* | ||||||
| Platelet count/μL | 80,000 | 1 | 70,000 | 1 | 60,000 | 1 |
| D-dimer, μg/mL | 2 | 2 | 2 | 2 | 3 | 2 |
| PT, seconds prolonged | 6 | 2 | 7 | 2 | 6 | 2 |
| Fibrinogen, mg/dL | 85 | 1 | 70 | 1 | 90 | 1 |
| Total ISH score | 6 | 6 | 6 | |||
| Other Coagulation Tests | ||||||
| ATIII level, % normal (nL) | 30–50 | 30–50 | 30–50 | |||
| Plasminogen level, % nL | 30–50 | 30–50 | 30–50 | |||
| Most coagulation factors, % nL | 30–50 | 30–50 | 30–50 | |||
| Factor VIII activity, % nL | 80–200 | 30–50 | 50–80 | |||
| PTT 1:1 mix with plasma | Usually corrects | Always corrects | Rarely corrects | |||
| Other Features | ||||||
| Pathophysiology | Decreased protein synthesis | Effects of dilution | Increased consumption | |||
| Thrombin generation | Intact but sluggish | Maintained | Excessive | |||
| Systemic hemorrhage | Uncommon | None | Characteristic | |||
| Systemic thrombosis | Rare | None | Characteristic | |||
| Hematologic treatment | Nonspecific | Platelets, fresh frozen plasma, cryoprecipitate | Aimed at any instigating circumstance | |||